Self-treatment by adults during slow-onset exacerbations of asthma

doi:10.1016/S0738-3991(97)00097-9

Patient Education and Counseling

Volume 32, Supplement 1, 1 December 1997, Pages S61-S66

https://doi.org/10.1016/S0738-3991(97)00097-9 Get rights and content

Abstract

Self-management plans are considered today an essential component of the management of asthma. The objective of the present study was (a) to explore patients' present practical knowledge of self-treatment of asthma, and (b) to provide an assessment of the effect of an educational program on this knowledge and self-treatment behaviour. Twenty four adults with asthma from the outpatient clinic of the Department of Pulmonary Medicine participated in a self-management program. They were provided with explanations on the symptoms and precipitating factors of their asthma, on its treatment with medication and their side-effects, and with personal written guidelines for self-adjustment of their medication. Prior to the program their practical knowledge of adequate self-treatment was investigated using a hypothetical scenario of a slow-onset asthma exacerbation. The effectiveness of the teaching and training program was evaluated by the change in knowledge prior to and 5 months after the program and self-reported behaviour of the participants at follow-up. (a) More than 60% of the patients lacked practical knowledge of self-treatment of a slow-onset exacerbation of asthma. (b) The educational program resulted in a significant increase (47%) of this knowledge. (c) Actual self-treatment behaviour, as recorded by the patients 5 months after completing the educational program, was adequate in only two of ten patients, who experienced an exacerbation during the study period. Many adults with asthma are deficient in practical knowledge of self-treatment of a slow-onset exacerbation. This knowledge was significantly augmented by an educational program. Nevertheless actual self-treatment behaviour at follow-up was inadequate in the majority of patients.

Introduction

Prompt recognition and treatment of deteriorating asthma can reduce the morbidity and mortality from this disease [1]. Consequently, patients should be encouraged to monitor relevant symptoms and/or peak expiratory flow (PEF) and to adjust their therapy or seek medical assistance, when necessary. Self-management plans are considered today an essential component of the management of adult asthma, especially for the moderate and severe patients 2, 3.

Because increased knowledge alone is not sufficient for adequate self-management 4, 5, asthma education programs should not only provide knowledge but also contain motivational techniques that can assist in the translation of knowledge into behavioural practices which will improve therapeutic outcomes. One way to do this, is by increasing the patients' self-efficacy expectations regarding self-treatment of asthma. This is mainly enforced by letting them experience successful self-treatment behaviour and by observing this in others 6, 7; group educational sessions that address successful self-treatment behaviour in one of the participants (e.g. showing an actual graph of a patient with improved PEF's, after doubling the dose of inhaled steroids) could have the potential to do so.

Although also advocated in the Netherlands [8], a structured asthma self-management and self-treatment program has not yet been developed and tested. The development of a program appropriate for the needs of Dutch adults with asthma, necessitated an insight into their present self-treatment habits. In a previous study by our group, results of which will be published elsewhere, a self-administered questionnaire was mailed to all subjects with asthma in a large city in the Netherlands. One of the questions was a hypothetical scenario of a slow-onset asthma exacerbation. Analysis of the answers showed that only a minority of the responders was familiar with adequate self-treatment (increase or start of inhaled or oral steroids in case of an exacerbation). The objective of the present study was to evaluate the effect of an educational program on patients' practical knowledge regarding and actual self-treatment behaviour during a slow-onset exacerbation of asthma.

Section snippets

Methods

The study was approved by the hospital's Ethics Committee.

Results

Responses to the questionnaire were obtained from 23 out of 24 patients before the teaching program, and from 22 patients 5 months later (Table 1). Although the vast majority of subjects prior to the intervention indicated that they would act in any way (83%) and would use more daily medication (84%), only 9 subjects would have increased inhaled or oral steroids and only one person would have started oral steroids. Practical knowledge of adequate self-treatment in case of a slow-onset

Discussion

The present study revealed three main findings. Firstly, before the educational program, practical knowledge of adequate self-treatment in case of slow-onset exacerbation of asthma among 23 adults, using inhaled steroids, was insufficient. Secondly, an educational program resulted in a significant increase in practical knowledge of correct self-treatment of exacerbations from 39% before the program to 86% 5 months after its completion. Lastly, actual self-treatment behaviour, as recorded by the

Acknowledgements

The authors acknowledge the help and support of the Netherlands Asthma Foundation (grant 94–52), GlaxoWellcome, and the OostNederland Health Care Insurance Fund, and thank the pulmonary-function technicians, chest physicians, and clerical staff of the Department of Pulmonary Medicine, who did so much to bring this work to a successful conclusion.

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View full text

Self-treatment by adults during slow-onset exacerbations of asthma

Abstract

Introduction

Section snippets

Methods

Results

Discussion

Acknowledgements

Chest

Chest

Lessons from the national asthma mortality study: circumstances surrounding death

New Zealand Med J

NHG-Standaard Astma bij, Volwassenen: Behandeling (Dutch General Practice guidelines asthma in adults)

Huisarts Wet

A self management plan in the treatment of adult asthma

Thorax